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Pham HQ, Pham KHT, Ha GH, Pham TT, Nguyen HT, Nguyen THT, Oh JK. Economic Burden of Chronic Obstructive Pulmonary Disease: A Systematic Review. Tuberc Respir Dis (Seoul) 2024; 87:234-251. [PMID: 38361331 PMCID: PMC11222094 DOI: 10.4046/trd.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/30/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
Globally, providing evidence on the economic burden of chronic obstructive pulmonary disease (COPD) is becoming essential as it assists the health authorities to efficiently allocate resources. This study aimed to summarize the literature on economic burden evidence for COPD from 1990 to 2019. This study examined the economic burden of COPD through a systematic review of studies from 1990 to 2019. A search was done in online databases, including Web of Science, PubMed/Medline, Scopus, and the Cochrane Library. After screening 12,734 studies, 43 articles that met the inclusion criteria were identified. General study information and data on direct, indirect, and intangible costs were extracted and converted to 2018 international dollars (Int$). Findings revealed that the total direct costs ranged from Int$ 52.08 (India) to Int$ 13,776.33 (Canada) across 16 studies, with drug costs rannging from Int$ 70.07 (Vietnam) to Int$ 8,706.9 (China) in 11 studies. Eight studies explored indirect costs, while one highlighted caregivers' direct costs at approximately Int$ 1,207.8 (Greece). This study underscores the limited research on COPD caregivers' economic burdens, particularly in developing countries, emphasizing the importance of increased research support, particularly in high-resource settings. This study provides information about the demographics and economic burden of COPD from 1990 to 2019. More strategies to reduce the frequency of hospital admissions and acute care services should be implemented to improve the quality of COPD patients' lives and reduce the disease's rising economic burden.
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Affiliation(s)
- Hai Quang Pham
- Department of Health Economics, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kiet Huy Tuan Pham
- Department of Health Economics, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Giang Hai Ha
- Institute of Theoretical and Applied Research, Duy Tan University, Danang, Vietnam
- School of Business and Economics, Duy Tan University, Danang, Vietnam
| | - Tin Trung Pham
- Can Tho University of Medicine and Pharmacy, Faculty of Public Health, Can Tho, Vietnam
| | - Hien Thi Nguyen
- Can Tho University of Medicine and Pharmacy, Faculty of Public Health, Can Tho, Vietnam
| | - Trang Huyen Thi Nguyen
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
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2
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Chen R, Cui Y, Mak JCW. Novel treatments against airway inflammation in COPD based on drug repurposing. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 98:225-247. [PMID: 37524488 DOI: 10.1016/bs.apha.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of death and reduces quality of life that contributes to a health problem worldwide. Chronic airway inflammation is a hallmark of COPD, which occurs in response to exposure of inhaled irritants like cigarette smoke. Despite accessible to the most up-to-date medications, none of the treatments is currently available to decrease the disease progression. Therefore, it is believed that drugs which can reduce airway inflammation will provide effective disease modifying therapy for COPD. There are many broad-range anti-inflammatory drugs including those that inhibit cell signaling pathways like inhibitors of p38 mitogen-activated protein kinase (MAPK), nuclear factor-κB (NF-κB), and phosphoinositide-3-kinase (PI3K), are now in phase III development for COPD. In this chapter, we review recent basic research data in the laboratory that may indicate novel therapeutic pathways arisen from currently used drugs such as selective monoamine oxidase (MAO)-B inhibitors and drugs targeting peripheral benzodiazepine receptors [also known as translocator protein (TSPO)] to reduce airway inflammation. Considering the impact of chronic airway inflammation on the lives of COPD patients, the potential pharmacological candidates for new anti-inflammatory targets should be further investigated. In addition, it is crucial to consider the phenotypes/molecular endotypes of COPD patients together with specific outcome measures to target novel therapies. This review will enhance our knowledge on how cigarette smoke affects MAO-B activity and TSPO activation/inactivation with specific ligands through regulation of mitochondrial function, and will help to identify new potential treatment for COPD in future.
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Affiliation(s)
- Rui Chen
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, P.R. China; Centre for Immunology and Infection, Hong Kong Science Park, Hong Kong SAR, P.R. China
| | - Yuting Cui
- School of Life Sciences and Medicine, Shandong University of Technology, Zibo, Shandong, P.R. China
| | - Judith C W Mak
- Department of Pharmacology & Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, P.R. China.
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3
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Jacobsen PA, Kragholm K, Torp-Pedersen C, Møller Weinreich U. Disability Retirement After First Admission with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Danish Nationwide Registry Cohort Study Using a Retrospective Follow-Up Design. Int J Chron Obstruct Pulmon Dis 2022; 17:2541-2551. [PMID: 36254163 PMCID: PMC9569162 DOI: 10.2147/copd.s377311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Many chronic obstructive pulmonary disease (COPD) patients below retirement age are outside the workforce. The existing knowledge about association between acute exacerbation of COPD (AECOPD) and disability retirement is limited. Aim The aim of this study is to explore disability retirement in COPD patients 3 years following first-ever AECOPD. Methods This retrospective registry-based follow-up cohort study design is based on nationwide Danish registry data. Patients admitted to the hospital for the first time between 1999 and 2017 with AECOPD and age between 35 and 59 years, active in the workforce, were included in the study. Socio-demographics, comorbidities and inhaled medication use were explored. COPD patients’ hazard ratio of disability retirement during 3-year follow-up was calculated. Cox regression was used to examine the effects of covariates on disability retirement. Results A total of 4032 patients were included in the study. During follow-up, 17.2% (692/4032) experienced disability retirement from the workforce. Factors associated with disability retirement were expressed as hazard ratio (95% confidence intervals): Higher age (ref. age 46–50: Age 51–55, 1.42, (1.12–1.81); age 56–59, 1.37 (1.08–1.74)); living alone (1.34 (1.14–1.56)); number of comorbidities for 1, 2, and 3 comorbidities (1.36 (1.14–1.62), 1.57 (1.19–2.07), 1.77 (1.20–2.60)); emphysema (2.01 (1.44–2.79)); depression (1.60 (1.12–2.28)); cardiac comorbidity (1.38 (1.07–1.78)); triple inhalation therapy (2.76 (2.20–3.47)); ICS + LAMA or ICS + LABA treatment (1.82 (1.48–2.23)); and ICS treatment (1.49 (1.17–1.90)). Higher educational level was associated with a significantly reduced risk of disability retirement, medium, short higher and long higher educational level, relative to low education level (0.78 (0.67–0.91), 0.63 (0.48–0.83) and 0.27 (0.12–0.60)). Conclusion Patients vulnerable to disability retirement are patients with markers of severe COPD, comorbidities, and social vulnerability.
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Affiliation(s)
- Peter Ascanius Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark,The Clinical Institute, Aalborg University, Aalborg, Denmark,Correspondence: Peter Ascanius Jacobsen, Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg, DK-9100, Denmark, Tel +4597664800, Email Mail:
| | - Kristian Kragholm
- The Clinical Institute, Aalborg University, Aalborg, Denmark,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark,The Clinical Institute, Aalborg University, Aalborg, Denmark
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4
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Ogbomo A, Tsang Y, Mallampati R, Panjabi S. The direct and indirect health care costs associated with pulmonary arterial hypertension among commercially insured patients in the United States. J Manag Care Spec Pharm 2022; 28:608-616. [PMID: 35621726 PMCID: PMC10372985 DOI: 10.18553/jmcp.2022.28.6.608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, progressive, and fatal disease associated with considerable overall clinical and economic burden. Although the direct health care costs of PAH have been well described, there are few data regarding indirect costs and productivity loss associated with PAH. Patient data were assessed until the earliest of death, end of full-time employment, end of continuous enrollment, or end of study period. OBJECTIVES: To update data on the direct burden and address the knowledge gap regarding the indirect burden associated with PAH. METHODS: This is a retrospective case-control study with prevalent and incident patients with PAH aged 18-64 years identified from the MarketScan Commercial and Health and Productivity management datasets during the identification period (January 1, 2016, to November 30, 2018). Patients were required to have continuous enrollment for 12 months or longer from the baseline period and 1 month or longer from the follow-up (post-index) period. Among patients with PAH (cases), the first observed PAH diagnosis claim date during the identification period was the index date. Patients without PAH (controls) were selected and assigned a random index date during the same period. Controls were matched 1:1 by age, sex, and region to prevalent and incident PAH cases. Per patient per month (PPPM), all-cause health care resource utilization, costs, and short-term disability (STD) were examined for cases and controls during the follow-up period. Multivariable analysis was performed using the generalized linear model to determine the adjusted direct and indirect health care utilization and costs. RESULTS: A total of 1,293 prevalent and 455 incident patients with PAH were identified. During the follow-up period, prevalent patients with PAH had significantly higher total mean all-cause health care costs ($9,915 vs $359, P < 0.0001) and inpatient length of stay (0.63 vs 0.02 days, P < 0.0001) PPPM as compared with controls. Prevalent patients with PAH had significantly longer STD (6.0 vs 1.5 days, P < 0.0001) and higher STD-related costs ($1,226 vs $277, P < 0.0001) PPPM as compared with controls. Incident patients with PAH had significantly higher total mean all-cause health care costs ($9,353 vs $336, P < 0.0001) and inpatient length of stay (0.92 vs 0.01 days, P < 0.0001) PPPM as compared with controls. Incident patients with PAH also had longer STD (8.1 vs 1.5 days, P < 0.0001) and higher STD-related costs ($1,706 vs $263, P < 0.0001), as compared with controls. CONCLUSIONS: This study showed that incident and prevalent patients with PAH had significantly higher direct and indirect health care resource utilization and costs as well as productivity loss compared with patients without PAH. DISCLOSURES: Ms Ogbomo and Mr Mallampati were paid employees of STATinMED Research at the time of study completion; STATinMED Research is a paid consultant to Janssen Scientific Affairs, LLC. Drs Tsang and Panjabi are employees of Janssen Scientific Affairs LLC, a subsidiary of Johnson and Johnson, the study sponsor.
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Affiliation(s)
| | - Yuen Tsang
- Janssen Scientific Affairs, Titusville, NJ
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5
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BAHA A, KÖKTÜRK N, ÖZTÜRK B, ÖZARI YILDIRIM E, ÖZMEN İ, GÜRGÜN A, TOPÇU AF, AKPINAR E, ELMAS F, SELİMOĞLU ŞEN H, OGAN N, ÖNDER Y, DOĞAN ÖT, POLATLI M, BİNGÖL Z, ECE T, ÇELİK E, AKGÜN M, ÖZGÜR ES, ATIŞ NAYCI S, ŞERİFOĞLU İ, ATEŞ C. The evaluation of disease awareness, caregiver burden, and workday loss in caregivers of COPD patients. Turk J Med Sci 2022; 52:346-353. [PMID: 36161606 PMCID: PMC10381183 DOI: 10.55730/1300-0144.5321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/14/2022] [Accepted: 01/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss. METHODS 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used. RESULTS 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (<0.068) and the number of comorbidities of patients (p = 0.01) and the number of comorbidities of caregivers (p = 0.003) increased the caregiving burden. DISCUSSION In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psychosocial and legal regulations should be investigated and solutions should be produced for the caregivers of COPD patients.
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Affiliation(s)
- Ayşe BAHA
- Department of Pulmonary Medicine, Faculty of Medicine, Near East University, Mersin,
Turkey
| | - Nurdan KÖKTÜRK
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkey
| | - Burcu ÖZTÜRK
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkey
| | - Elif ÖZARI YILDIRIM
- Department of Pulmonary Medicine, Süreyyapaşa Training and Research Hospital, İstanbul,
Turkey
| | - İpek ÖZMEN
- Department of Pulmonary Medicine, Süreyyapaşa Training and Research Hospital, İstanbul,
Turkey
| | - Alev GÜRGÜN
- Department of Pulmonary Medicine, Faculty of Medicine, Ege University, İzmir,
Turkey
| | - Ayşe Füsun TOPÇU
- Department of Pulmonary Medicine, Faculty of Medicine, Dicle University, Diyarbakır,
Turkey
| | - Eylem AKPINAR
- Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara,
Turkey
| | - Funda ELMAS
- Department of Pulmonary Medicine, Faculty of Medicine, Ege University, İzmir,
Turkey
| | - Hadice SELİMOĞLU ŞEN
- Department of Pulmonary Medicine, Faculty of Medicine, Dicle University, Diyarbakır,
Turkey
| | - Nalan OGAN
- Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara,
Turkey
| | - Yeşim ÖNDER
- Department of Pulmonary Medicine, Faculty of Medicine, Cumhuriyet University, Sivas,
Turkey
| | - Ömer Tamer DOĞAN
- Department of Pulmonary Medicine, Faculty of Medicine, Cumhuriyet University, Sivas,
Turkey
| | - Mehmet POLATLI
- Department of Pulmonary Medicine, Faculty of Medicine, Adnan Menderes University, Aydın,
Turkey
| | - Züleyha BİNGÖL
- Department of Pulmonary Medicine, Faculty of Medicine, İstanbul University, İstanbul,
Turkey
| | - Turhan ECE
- Department of Pulmonary Medicine, Faculty of Medicine, İstanbul University, İstanbul,
Turkey
| | - Eda ÇELİK
- Department of Pulmonary Medicine, Faculty of Medicine, Atatürk University, Erzurum,
Turkey
| | - Metin AKGÜN
- Department of Pulmonary Medicine, Faculty of Medicine, Atatürk University, Erzurum,
Turkey
| | - Eylem Sercan ÖZGÜR
- Department of Pulmonary Medicine, Faculty of Medicine, Mersin University, Mersin,
Turkey
| | - Sibel ATIŞ NAYCI
- Department of Pulmonary Medicine, Faculty of Medicine, Mersin University, Mersin,
Turkey
| | - İrem ŞERİFOĞLU
- Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, Ankara,
Turkey
| | - Can ATEŞ
- Department of Biostatistics, Faculty of Medicine, Yüzüncüyıl University, Van,
Turkey
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6
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Sevic A, Hashemi NS, Thørrisen MM, Strømstad K, Skarpaas LS, Storm M, Brønnick KK. Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review (Preprint). J Med Internet Res 2022; 25:e38307. [PMID: 37079369 PMCID: PMC10160931 DOI: 10.2196/38307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/12/2022] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings. OBJECTIVE We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions. METHODS A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. RESULTS In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%). CONCLUSIONS This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges. TRIAL REGISTRATION PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777.
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Affiliation(s)
- Aleksandra Sevic
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Neda S Hashemi
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mikkel Magnus Thørrisen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Kine Strømstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Lisebet Skeie Skarpaas
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Kolbjørn Kallesten Brønnick
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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7
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Ganbat M, Erdenebileg N, Batbold C, Nergui S, Anderson R, Wigfall C, Amarsanaa N, Heikens A, Sarantuya M, Warburton D. Integrating quantitative and qualitative approaches to assess wintertime illness-related absenteeism and its direct and indirect costs among the private sector in Ulaanbaatar. PLoS One 2022; 17:e0263220. [PMID: 35113912 PMCID: PMC8812901 DOI: 10.1371/journal.pone.0263220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Causes for employee absenteeism vary. The commonest cause of work absenteeism is “illness-related.” Mongolia’s capital city, Ulaanbaatar, experiences high employee absenteeism during the winter than during other seasons due to the combination of extreme cold and extreme air pollution. We identified direct and indirect costs of absenteeism attributed to air pollution among private-sector employees in Ulaanbaatar. Using a purposive sampling design, we obtained questionnaire data for 1,330 employees working for private-sector companies spanning six economic sectors. We conducted 26 employee focus groups and 20 individual employer in-depth interviews. We used both quantitative and qualitative instruments to characterize the direct and indirect costs of absence due to illnesses attributed to severe air pollution during wintertime. Female employees and employees with a young child at home were more likely to be absent. Respiratory diseases accounted for the majority of reported air pollution-related illnesses. All participants perceived that air pollution adversely affected their health. Individual employee direct costs related to absence totaled 875,000 MNT ($307.10) for an average of three instances of three-day illness-related absences during the winter. This sum included diagnostic and doctor visit-related, medication costs and hospitalization costs. Non-healthcare-related direct cost (transportation) per absence was 50,000₮ ($17.60). Individual indirect costs included the value of lost wages for the typical 3-day absence, amounting to 120,000₮ ($42.10). These total costs to employees, therefore, may amount to as much as 10% of annual income. The majority of sick absences were unpaid. Overall, the cost of wintertime absences is substantial and fell disproportionately on female employees with young children.
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Affiliation(s)
- Mandukhai Ganbat
- Department of Epidemiology and Biostatistics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- * E-mail:
| | | | - Chuluunbileg Batbold
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Saruultuya Nergui
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Ron Anderson
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Clarence Wigfall
- Department of Applied Social Psychology, Claremont Graduate University, Claremont, California, United States of America
| | | | - Alex Heikens
- United Nations Children Fund, Ulaanbaatar, Mongolia
| | | | - David Warburton
- Department of Surgery, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, United States of America
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8
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Zabczyk C, Blakey JD. The Effect of Connected "Smart" Inhalers on Medication Adherence. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:657321. [PMID: 35047916 PMCID: PMC8757760 DOI: 10.3389/fmedt.2021.657321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent worldwide, and major sources of morbidity. Key barriers to reduce the harm from these conditions are the widespread and related issues of low use of prescribed inhaled therapy, use of medicines differently from that prescribed, suboptimal inhaler technique, and lack of adherence are the action plans. Connected smart inhalers show great potential to improve these issues, and thus outcomes from airways disease. In this mini-review, we considered the published evidence that the use of smart inhalers leads to more doses of preventative treatment being taken on time and with appropriate techniques. We found multiple trials across a variety of settings and age groups where smart inhalers were used with audio-visual reminders and healthcare professional feedback, which substantially improved the number of doses of preventative treatment taken. Trial evidence also supports the use of feedback from smart inhalers in improving true concordance (doses taken correctly and on time), though only for a single type of smart device. The relative lack of study is in contrast with the potential impact of smart inhalers. Major research questions remain unresolved, as who might fund future large-scale studies, how guideline committees may consider them, and how to implement effective solutions.
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Affiliation(s)
- Caroline Zabczyk
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Medical School, Curtin University, Perth, WA, Australia
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9
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Cravo A, Attar D, Freeman D, Holmes S, Ip L, Singh SJ. The Importance of Self-Management in the Context of Personalized Care in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:231-243. [PMID: 35095272 PMCID: PMC8791295 DOI: 10.2147/copd.s343108] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 01/13/2023] Open
Abstract
Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.
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Affiliation(s)
- Ana Cravo
- Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, UK
| | - Darush Attar
- North Central London Clinical Commissioning Group (CCG), London, UK
| | | | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, UK
- Correspondence: Steve Holmes The Park Medical Practice, Cannard’s Grave Road, Shepton Mallet, Somerset, BA4 5RT, UKTel +44 1749 334383 Email
| | - Lindsay Ip
- King’s Health Partners and Ealing Community Partners, London, UK
| | - Sally J Singh
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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10
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Daniel RA, Aggarwal P, Kalaivani M, Gupta SK. Prevalence of chronic obstructive pulmonary disease in India: A systematic review and meta-analysis. Lung India 2021; 38:506-513. [PMID: 34747730 PMCID: PMC8614617 DOI: 10.4103/lungindia.lungindia_159_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objective: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide. There is a lack of national-level estimates on the magnitude of COPD in India. Hence, we estimated the prevalence of COPD among adults in India. Methods: We searched PubMed, Embase, Cochrane Library, Google Scholar, and Scopus and included community-based cross-sectional studies reporting data on the prevalence of COPD among adults based on spirometry. A random-effects model was used to estimate the pooled prevalence of COPD. Results: In the eight identified studies, (pooled sample of 8,569 individuals), the estimated prevalence was 7.4% (95% confidence interval: 5.0%–9.8%), I2 = 95.4% (P < 0.001). The prevalence was higher among males, in the urban area, and the northern region. Conclusion: Adequate training and resources should be provided to diagnose COPD at primary health care level for early management. A nationwide population-based survey is indicated to provide reliable estimates of the burden to inform evidence-based community-based interventions.
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Affiliation(s)
- Roy Arokiam Daniel
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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11
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Marques ML, Alunno A, Boonen A, Ter Wee MM, Falzon L, Ramiro S, Putrik P. Methodological aspects of design, analysis and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis: results of two systematic literature reviews informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2020-001522. [PMID: 33542048 PMCID: PMC7868290 DOI: 10.1136/rmdopen-2020-001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To summarise the methodological aspects in studies with work participation (WP) as outcome domain in inflammatory arthritis (IA) and other chronic diseases. Methods Two systematic literature reviews (SLRs) were conducted in key electronic databases (2014–2019): search 1 focused on longitudinal prospective studies in IA and search 2 on SLRs in other chronic diseases. Two reviewers independently identified eligible studies and extracted data covering pre-defined methodological areas. Results In total, 58 studies in IA (22 randomised controlled trials, 36 longitudinal observational studies) and 24 SLRs in other chronic diseases were included. WP was the primary outcome in 26/58 (45%) studies. The methodological aspects least accounted for in IA studies were as follows (proportions of studies positively adhering to the topic are shown): aligning the studied population (16/58 (28%)) and sample size calculation (8/58 (14%)) with the work-related study objective; attribution of WP to overall health (28/58 (48%)); accounting for skewness of presenteeism/sick leave (10/52 (19%)); accounting for work-related contextual factors (25/58 (43%)); reporting attrition and its reasons (1/58 (2%)); reporting both aggregated results and proportions of individuals reaching predefined meaningful change or state (11/58 (16%)). SLRs in other chronic diseases confirmed heterogeneity and methodological flaws identified in IA studies without identifying new issues. Conclusion High methodological heterogeneity was observed in studies with WP as outcome domain. Consensus around various methodological aspects specific to WP studies is needed to improve quality of future studies. This review informs the EULAR Points to Consider for conducting and reporting studies with WP as an outcome in IA.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands .,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Umbria, Italy
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louise Falzon
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
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12
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Oxidative Stress Promotes Corticosteroid Insensitivity in Asthma and COPD. Antioxidants (Basel) 2021; 10:antiox10091335. [PMID: 34572965 PMCID: PMC8471691 DOI: 10.3390/antiox10091335] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Corticosteroid insensitivity is a key characteristic of patients with severe asthma and COPD. These individuals experience greater pulmonary oxidative stress and inflammation, which contribute to diminished lung function and frequent exacerbations despite the often and prolonged use of systemic, high dose corticosteroids. Reactive oxygen and nitrogen species (RONS) promote corticosteroid insensitivity by disrupting glucocorticoid receptor (GR) signaling, leading to the sustained activation of pro-inflammatory pathways in immune and airway structural cells. Studies in asthma and COPD models suggest that corticosteroids need a balanced redox environment to be effective and to reduce airway inflammation. In this review, we discuss how oxidative stress contributes to corticosteroid insensitivity and the importance of optimizing endogenous antioxidant responses to enhance corticosteroid sensitivity. Future studies should aim to identify how antioxidant-based therapies can complement corticosteroids to reduce the need for prolonged high dose regimens in patients with severe asthma and COPD.
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13
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Lee DW, Lee J, Kim HR, Kang MY. Health-Related Productivity Loss According to Health Conditions among Workers in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7589. [PMID: 34300042 PMCID: PMC8307799 DOI: 10.3390/ijerph18147589] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to investigate the degree of health-related productivity loss (HRPL) for common health conditions. A total of 4197 workers participated in a web-based questionnaire survey from January to February 2020. HRPL was measured using the Work Productivity and Activity Impairment questionnaire, and a difference in HRPL was calculated for each common health condition. The burden of productivity loss due to each health condition was calculated by the product of the difference in HRPL scores and the percentage of participants who complained. The health conditions most strongly associated with increased HRPL were infertility treatment (30.6%), osteoporosis (25.9%), cancer (25.3%), gastric ulcer or duodenal ulcer (25.0%) and anaemia (23.9%). The most important health conditions in order of their magnitude of induced burden of productivity loss were fatigue, neck or shoulder pain, insufficient sleep, back pain, headache, common cold and flu, insomnia, anxiety and diarrhoea or constipation. HRPL is more strongly and importantly associated with the aforementioned health conditions. Occupational health managers should prioritise addressing health conditions strongly and importantly associated with HRPL when implementing health promotion programmes.
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Affiliation(s)
- Dong-Wook Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 08826, Korea;
| | - Jongin Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea; (J.L.); (H.-R.K.)
| | - Hyoung-Ryoul Kim
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea; (J.L.); (H.-R.K.)
| | - Mo-Yeol Kang
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea; (J.L.); (H.-R.K.)
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14
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Cave A, Pham A, Lindeman C, Soos B, Williamson T, Drummond N. Chronic obstructive pulmonary disease as a risk factor in primary care: a Canadian retrospective cohort study. NPJ Prim Care Respir Med 2021; 31:37. [PMID: 34168156 PMCID: PMC8225780 DOI: 10.1038/s41533-021-00249-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex disease that is predicted to be the third most common cause of death by 2030. In Canada, the care and management of chronic conditions is largely provided by primary care providers. Although there is emerging research and initiatives that describe the prevalence of COPD in Canadian primary care settings, to our knowledge, there have been no efforts to use a large pan-Canadian database to analyze COPD as a risk factor for other common chronic conditions managed in primary care. We report the risk of developing comorbidities after the onset of COPD, that is, the extent to which COPD is a risk factor for developing common chronic conditions (heart failure, depression, anxiety, coronary artery disease, diabetes, anemia, hypertension, ischemic heart disease, underweight, and osteoporosis). After adjusting for age, sex, urban vs rural residence, and smoking status, the relative risks for patients with COPD at baseline were significantly higher for subsequent incidence of anemia, anxiety, diabetes, depression, heart failure, ischemic heart disease, lung cancer, osteoporosis, sleep apnea, underweight, and hypertension than patients without COPD. Using a cut-point of a 200% increase in relative risk as indicative of particular clinical relevance, COPD has a statistically and clinically significant association with developing lung cancer, becoming underweight, and developing heart failure.
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Affiliation(s)
- Andrew Cave
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Anh Pham
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Cliff Lindeman
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Boglarka Soos
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Neil Drummond
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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15
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Rana R, Gow J, Moloney C, King A, Keijzers G, Beccaria G, Mullens A. Estimating the frequency and cost of emergency department presentations and hospitalisation of chronic obstructive pulmonary disease patients: A retrospective analysis from regional Queensland. Emerg Med Australas 2021; 33:491-498. [PMID: 33128441 DOI: 10.1111/1742-6723.13665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/19/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) patients commonly have frequent visits to the ED. Consequently, COPD has a significant effect on total healthcare expenditure. The objective was to measure the frequency of ED presentation and hospitalisation among COPD patients and to estimate the costs resulting from such care utilisation. METHODS This was a causal-comparative non-experimental research design conducted in three regional hospitals between 2016 and 2018. Two different original data sets were used: an automated hospital data set and an audit of patient charts. Secondary cost data were also used. Data were analysed using Pearson's χ2 test to estimate the relationship between several patient and treatment-related characteristics. RESULTS There were 5253 patient presentations at ED and hospital length of stay data were available for 5079 COPD patients. The total cost of hospital stays was $42.14 million for the time period and the mean average cost was $8297 for ED patients who were admitted to hospital. Factors significantly associated with hospital length of stay were age and time spent in the ED. Noticeably, one (51.7%) in two COPD patients were discharged from ED (all destinations) within 4 h irrespective of their triage category. CONCLUSIONS COPD patient presentation to ED and admission to hospital is an expensive method of providing healthcare to manage this chronic condition. Clinical practitioners and policy makers need to develop and implement optimal integrated care management systems to reduce this hospitalisation rate and reduce the societal costs associated with COPD patient management.
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Affiliation(s)
- Rezwanul Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Alex King
- Emergency Department, Toowoomba Hospital, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Gavin Beccaria
- School of Psychology, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Amy Mullens
- School of Psychology, University of Southern Queensland, Toowoomba, Queensland, Australia
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16
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Salem A, Zhong H, Ramos M, Lamotte M, Hu H. Potential clinical and economic impact of optimised maintenance therapy on discharged patients with COPD after hospitalisation for an exacerbation in China. BMJ Open 2021; 11:e043664. [PMID: 33910947 PMCID: PMC8094343 DOI: 10.1136/bmjopen-2020-043664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalisation are a considerable burden, both clinically and economically. Although long-acting maintenance therapy is recommended in both the GOLD (Global Initiative for Chronic Obstructive Lung Disease) and Chinese COPD guidelines, proper implementation is lacking. The objective of this study was to assess the clinical and economic impact of prescribing long-acting maintenance therapy to discharged patients with COPD after hospitalisation for an exacerbation in China by using an outcomes model. DESIGN This health economic analysis was conducted using a Markov cohort model from the Chinese healthcare payer perspective. Two health states (alive and dead) were modelled, and exacerbations were included as possible events. SETTING The target population was Chinese patients with COPD, >40 years of age, who were hospitalised for an exacerbation, with 1 year of follow-up. A recent COPD national prevalence study was referenced for population calculations. INTERVENTION A hypothetical future scenario, where 100% of patients would receive long-acting maintenance therapy after hospitalisation for an exacerbation, was compared with the current scenario, in which only 38.5% of patients are receiving long-acting maintenance therapy after hospitalisation. OUTCOME MEASURES Number of exacerbations, deaths and medical costs were measured. RESULTS We estimated that there were approximately 4 million Chinese patients with COPD who were hospitalised annually due to an exacerbation. By prescribing long-acting maintenance therapy, our model predicted that 917 360 exacerbations and 4034 deaths could be avoided, translating into cost savings of ¥3.5 billion (US$0.5 billion). Scenario analysis also showed that if the rate of exacerbations requiring hospitalisation was higher than our base case analysis, cost savings could reach up to ¥10.7 billion (US$1.5 billion). CONCLUSION Administering long-acting maintenance therapy to more patients with COPD at hospital discharge could considerably reduce exacerbations and healthcare spending in China.
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Affiliation(s)
- Ahmed Salem
- Real World Evidence, IQVIA, Zaventem, Belgium
| | - Heng Zhong
- R&D China, AstraZeneca R&D, Shanghai, China
| | | | | | - Hao Hu
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
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17
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Lee E. Defining Phenotypes of COPD Through Anatomic and Functional Imaging. Acad Radiol 2021; 28:379-380. [PMID: 32917476 DOI: 10.1016/j.acra.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth Lee
- Department for Radiology, University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr SPC 5030, Ann Arbor, MI 48109.
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18
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Dierick BJH, Flokstra-de Blok BMJ, van der Molen T, Toledo-Pons N, Román-Rodríguez M, Cosío BG, Soriano JB, Kocks JWH, van Boven JFM. Work absence in patients with asthma and/or COPD: a population-based study. NPJ Prim Care Respir Med 2021; 31:9. [PMID: 33594082 PMCID: PMC7887233 DOI: 10.1038/s41533-021-00217-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and asthma impact on work productivity, but their population-based burden and clinical predictors are understudied. In this observational, real-life study, work absence of 14,383 asthma and/or COPD patients present in the MAJORICA cohort (Spain) was compared with the general population. Using multivariable regression, we studied the association of work absence with demographic and clinical characteristics. Patients with asthma and/or COPD had more work absence than the general population (15.2% vs 8.9%, p < 0.0001). Patients with asthma had more often periods of work absence compared to patients with COPD (16.0% vs 12.8%, p < 0.0001). The number of days absent were, however, less in asthma than in COPD (median: 15 days [IQR: 5–51] vs 39 days [IQR: 13–134], p < 0.001). Patients with asthma–COPD overlap were in between (14.5% with absence; median: 27 days [IQR: 10–82]). Comorbid anxiety, allergic rhinitis, and sleep apnoea were independently associated with more work absence.
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Affiliation(s)
- Boudewijn J H Dierick
- University of Groningen, University Medical Center Groningen, Groningen Institute for Asthma and COPD (GRIAC), Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands.
| | | | - Thys van der Molen
- University of Groningen, University Medical Center Groningen, Groningen Institute for Asthma and COPD (GRIAC), Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands
| | - Núria Toledo-Pons
- Department of Respiratory Medicine, Hospital Universitario Son Espases, and CIBERES, Madrid, Spain.,Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain
| | - Miguel Román-Rodríguez
- University of Groningen, University Medical Center Groningen, Groningen Institute for Asthma and COPD (GRIAC), Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands.,Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain.,Primary Care Health Service, Servei de Salut de les Illes Balears, Palma de Mallorca, Spain
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases, and CIBERES, Madrid, Spain.,Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Institute for Asthma and COPD (GRIAC), Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands
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19
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Choi HS, Yang DW, Rhee CK, Yoon HK, Lee JH, Lim SY, Kim YI, Yoo KH, Hwang YI, Lee SH, Park YB. The health-related quality-of-life of chronic obstructive pulmonary disease patients and disease-related indirect burdens. Korean J Intern Med 2020; 35:1136-1144. [PMID: 32066224 PMCID: PMC7487298 DOI: 10.3904/kjim.2018.398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIMS Many chronic obstructive pulmonary disease (COPD) patients have physical limitations. We investigated EuroQol five-dimensions five-level (EQ-5D-5L) of COPD patients to assess quality of life, and assessed indirect burden including time expenditure to visit doctor, home care rate, and caregiver related burden. METHODS We recruited 355 COPD patients according to severity of airflow limitation that severity was set at 10% mild, 40% moderate, 30% severe, and 20% very severe in two primary and 11 secondary/tertiary hospitals. Eligible patients were aged ≥ 40 years, who have been diagnosed with COPD for more than 1 year. Patients were recruited between June 2015 and October 2016. RESULTS The quality of life tended to decline with age, from mild to very severe impairment, as revealed by the EQ-5D-5L scores and the EQ visual analog scale. Family caregivers accompanied 22.6% of patients who visited outpatient clinics, and 25% of stage IV COPD patients. During emergency visits and hospitalization, this figure increased to > 60%. The home care rates were 28.5% for stage I patients, and 34.4, 31.8, and 52% for stage II to IV patients, respectively. The percentage of caregivers who stopped working was 13.6%. The EQ-5D index was strongly associated with the dyspnea scale (r = -0.64, p < 0.001). The average required time to see a doctor and visit the pharmacy was 154 minutes. CONCLUSION In patients with COPD, the EQ-5D index decreased and disease-related home caregiving increased with airflow limitation. We considered the caregiver- related burden when making a strategy for COPD management.
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Affiliation(s)
- Hye Sook Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong-Wook Yang
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hwa Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong Yong Lim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu-Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
- Correspondence to Yong Bum Park, M.D. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea Tel: +82-2-2225-2754, Fax: +82-2-2224-2569, E-mail:
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20
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Chow EJ, Rolfes MA, Carrico RL, Furmanek S, Ramirez JA, Ferdinands JM, Fry AM, Patel MM. Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010-2013. Open Forum Infect Dis 2020; 7:ofaa262. [PMID: 32715020 DOI: 10.1093/ofid/ofaa262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023] Open
Abstract
Background Preventing severe complications of influenza such as hospitalization is a public health priority; however, estimates of influenza vaccine effectiveness (VE) against influenza-associated acute lower respiratory tract infection (LRTI) hospitalizations are limited. We examined influenza VE against influenza-associated LRTIs in hospitalized adult patients. Methods We retrospectively analyzed data from a randomized trial of oseltamivir treatment in adults hospitalized with LRTI in Louisville, Kentucky, from 2010 to 2013. Patients were systematically tested for influenza at the time of enrollment. We estimated VE as 1 - the adjusted odds ratio (aOR) of antecedent vaccination in influenza-positives vs negatives × 100%. Vaccination status was obtained by patient self-report. Using logistic regression adjusting for age, sex, season, timing of illness, history of chronic lung disease, and activities of daily living, we estimated VE against hospitalized influenza-associated LRTIs and community-acquired pneumonia (CAP) with radiographic findings of infiltrate. Results Of 810 patients with LRTI (median age, 62 years), 184 (23%) were influenza-positive and 57% had radiographically confirmed CAP. Among influenza-positives and -negatives, respectively, 61% and 69% were vaccinated. Overall, 29% were hospitalized in the prior 90 days and >80% had comorbidities. Influenza-negatives were more likely to have a history of chronic obstructive pulmonary disease than influenza-positives (59% vs 48%; P = .01), but baseline medical conditions were otherwise similar. Overall, VE was 35% (95% CI, 4% to 56%) against influenza-associated LRTI and 51% (95% CI, 13% to 72%) against influenza-associated radiographically confirmed CAP. Conclusions Vaccination reduced the risk of hospitalization for influenza-associated LRTI and radiographically confirmed CAP. Clinicians should maintain high rates of influenza vaccination to prevent severe influenza-associated complications.
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Affiliation(s)
- Eric J Chow
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth L Carrico
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Stephen Furmanek
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jill M Ferdinands
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Schofield SJ, Woods A, Szram J, Newman Taylor AJ, Cullinan P. Chronic Obstructive Pulmonary Disease and Breathlessness in Older Workers Predict Economic Inactivity. A Prospective Cohort Study. Am J Respir Crit Care Med 2020; 200:1228-1233. [PMID: 31348686 DOI: 10.1164/rccm.201902-0297oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: There is an aspiration to retain increasing numbers of older workers in employment, and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes.Objectives: We report the findings of the first longitudinal study of this issue.Methods: We recruited full-time employed men and women in their 50s and followed them for a period of 18 months; we examined, after adjustment for potential confounders, the associations between breathlessness and airway obstruction at baseline and loss of employment in the intervening period.Measurements and Main Results: Among participants responding to the follow-up questionnaire (1,656 of 1,773 [93%]), the majority (78.5%) continued in full-time employment, but 10.6% were in part-time employment and 10.9% were no longer in paid employment. The adjusted risk of loss of employment was significantly increased for those with moderate or severe chronic obstructive pulmonary disease (risk ratio, 2.89; 95% confidence interval, 1.80-4.65) or breathlessness (risk ratio, 3.07; 95% confidence interval, 2.16-4.37) at baseline. There was no evident modification by sex or by manual/nonmanual work.Conclusions: Airway obstruction and breathlessness are independently associated with premature loss from the workforce in older workers; these observations provide strong support to the available cross-sectional evidence and suggest that interventions to help those with chronic obstructive pulmonary disease who wish to remain in work need to be tested.
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Affiliation(s)
- Susie J Schofield
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Annette Woods
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Joanna Szram
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.,Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Anthony J Newman Taylor
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Paul Cullinan
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.,Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
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Zhang S, King D, Rosen VM, Ismaila AS. Impact of Single Combination Inhaler versus Multiple Inhalers to Deliver the Same Medications for Patients with Asthma or COPD: A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis 2020; 15:417-438. [PMID: 32161454 PMCID: PMC7049753 DOI: 10.2147/copd.s234823] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/24/2020] [Indexed: 01/23/2023] Open
Abstract
With increasing choice of medications and devices for asthma and chronic obstructive pulmonary disease (COPD) treatment, comparative evidence may inform treatment decisions. This systematic literature review assessed clinical and economic evidence for using a single combination inhaler versus multiple inhalers to deliver the same medication for patients with asthma or COPD. In 2016, Embase, PubMed and the Cochrane library were searched for publications reporting studies in asthma or COPD comparing a single-inhaler combination medicine with multiple inhalers delivering the same medication. Publications included English-language articles published since 1996 and congress abstracts since 2013. Clinical, economic and adherence endpoints were assessed. Of 2031 abstracts screened, 18 randomized controlled trials (RCTs) in asthma and four in COPD, nine retrospective and three prospective observational studies in asthma, and four observational studies in COPD were identified. Of these, five retrospective and one prospective study in asthma, and two retrospective studies in COPD reported greater adherence with a single inhaler than multiple inhalers. Nine observational studies reported significantly (n=7) or numerically (n=2) higher rates of adherence with single- versus multiple-inhaler therapy. Economic analyses from retrospective and prospective studies showed that use of single-inhaler therapies was associated with reduced healthcare resource use (n=6) and was cost-effective (n=5) compared with multiple-inhaler therapies. Findings in 18 asthma RCTs and one prospective study reporting lung function, and six RCTs reporting exacerbation rates, showed no significant differences between a single inhaler and multiple inhalers. This was in contrast to several observational studies reporting reductions in healthcare resource use or exacerbation events with single-inhaler treatment, compared with multiple inhalers. Retrospective and prospective studies showed that single-inhaler use was associated with decreased healthcare resource utilization and improved cost-effectiveness compared with multiple inhalers. Lung function and exacerbation rates were mostly comparable in the RCTs, possibly due to study design.
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Affiliation(s)
- Shiyuan Zhang
- Value Evidence and Outcomes, GlaxoSmithKline plc, Collegeville, PA, USA
| | - Denise King
- Value Evidence and Outcomes, GlaxoSmithKline plc, Brentford, UK
| | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline plc, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Lindström I, Pallasaho P, Remes J, Vasankari T, Heliövaara M. Does lung function predict the risk of disability pension? An 11-year register-based follow-up study. BMC Public Health 2020; 20:165. [PMID: 32013933 PMCID: PMC6998269 DOI: 10.1186/s12889-020-8277-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Spirometry is widely used in medical surveillance in occupational health and as a diagnostic test for obstructive and restrictive lung disease. We evaluated the effect of spirometry parameters on the risk of all-cause disability pension in a follow-up study of an occupationally active general population-based cohort. Methods We measured the pulmonary function of 3386 currently working participants of the Health 2000 Survey in the clinical phase at baseline using spirometry. We obtained the retirement events of the cohort from the nationwide register for 2000–2011. Cox proportional hazards models were used to determine disability pensions. Results At baseline, we identified 111 (3.3%) participants with obstructive spirometry, 95 (2.8%) with restrictive spirometry, and 3180 controls without restriction or obstruction. The age, sex, educational level, body-mass index, co-morbidities (1 or ≥ 2), and the smoking-adjusted hazard ratio of disability pension was 1.07 (95% confidence interval, CI 0.64–1.78) for those with obstructive spirometry, and 1.44 (95% CI 0.89–2.32) for those with restrictive spirometry. As continuous variables, and divided into quartiles, the risk of the lowest quartile of forced ventilation capacity (FVC)% of predicted was 1.49 (95%CI 1.10–2.01) and forced expiratory volume in one second (FEV1)% of predicted 1.66 (95%CI: 1.23–2.24) in comparison to the highest quartile in the adjusted models. Conclusions Obstructive or restrictive spirometry did not predict disability pension when dichotomized classified variables (normal compared to abnormal) were used. As continuous variables and when divided into quartiles, lower lung volumes showed an increase in the risk of disability pension. Physicians should take this into account when they use spirometry as a prognostic factor of work disability.
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Affiliation(s)
- Irmeli Lindström
- Occupational Medicine, Finnish Institute of Occupational Health, Topeliuksenkatu 41 B, 00250, Helsinki, Finland.
| | | | - Jouko Remes
- Statistical Services Team, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula Vasankari
- Finnish Lung Health Association (Filha ry), Helsinki, Finland.,Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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Halpin D. Chronic Obstructive Pulmonary Disease and Work: Is It Time to Stop? Am J Respir Crit Care Med 2019; 200:1195-1197. [PMID: 31513746 PMCID: PMC6857494 DOI: 10.1164/rccm.201908-1627ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- David Halpin
- University of Exeter Medical SchoolUniversity of Exeter College of Medicine and HealthExeter, United Kingdomand.,Royal Devon and Exeter HospitalExeter, United Kingdom
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25
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The Social and Economic Impact of Chronic Obstructive Pulmonary Disease on Maintenance-of-Way Railroad Workers. J Occup Environ Med 2019; 62:58-63. [PMID: 31658222 DOI: 10.1097/jom.0000000000001757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Thousands of railroad maintenance-of-way (MOW) workers develop chronic obstructive pulmonary disease (COPD) from their work. OBJECTIVE This study calculates the social and economic burdens of COPD borne by thousands of MOW workers. METHODS Economic calculations are derived from the literature and also from a survey of 4800 MOW respondents, 155 in-depth interviews, and two focus groups. RESULTS COPD alone costs at least $179 million over the course of cases currently diagnosed among MOW workers. Many individuals work through significant pain and breathing difficulties or have to leave the profession. Some are crippled for life. CONCLUSION When a worker has COPD, beyond pain and suffering, there are often financial burdens that affect families, railroad companies, insurers, communities, and taxpayers as well as the injured workers.
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Li X, Zhang W, Sun H, Anis AH. Effects of health status on work exit and absenteeism among the older working population in China: a secondary analysis of a cohort sample. BMJ Open 2019; 9:e024115. [PMID: 31501093 PMCID: PMC6738687 DOI: 10.1136/bmjopen-2018-024115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyse the effects of health status on work exit and absenteeism among the older working population in China. DESIGN Secondary analysis of a cohort sample. SETTING AND PARTICIPANTS Community samples who engaged in either agricultural or non-agriculture work or both in the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS) and whose age was 45-55 years for women or 45-60 years for men in the 2013 wave. OUTCOME MEASURES Work exit and number of absent workdays due to health problems in 2013. To address the problems of measurement error of self-rated health status, we used disability condition, number of chronic diseases and functional limitation to construct an index of health. We divided the sample into four groups according to gender and work types (farmers who conducted any agricultural work in 2011 vs non-farmers who conducted non-agricultural work only) and conducted analyses separately. RESULTS Farmers (11.0% for women and 4.9% for men) were less likely to exit from work than non-farmers (18.5% and 12.0%, respectively) but took more absent workdays (16.6 days for women and 15.0 days for men) than non-farmers (5.6 and 4.9). Poor health status in 2011 was significantly associated with the work exit in 2013 of female and male farmers but not non-farmers. Older workers (except female non-farmers) with persistently poor health or recent health deterioration over time were significantly more likely to stop working or missed more workdays than those with persistently good health. CONCLUSIONS Poor 2-year lagged health predicts work exit for both male and female farmers, and increases the absent work days in all older working population. Persistently poor health or recent health deterioration over time has detrimental impact on labour market in terms of work exit and absenteeism among all older Chinese workers except for female non-farmers.
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Affiliation(s)
- Xin Li
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Wei Zhang
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Sansgiry SS, Bhansali A, Serna O, Kamdar M, Fleming M, Abughosh S, Stanford RH. Effect of coverage gap on healthcare utilization among Medicare beneficiaries with chronic obstructive pulmonary disorder. Curr Med Res Opin 2019; 35:321-328. [PMID: 29962241 DOI: 10.1080/03007995.2018.1495622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the association between the Medicare coverage gap with hospitalization, emergency room (ER) visits, and time to hospitalization in chronic obstructive pulmonary disease (COPD) patients. METHODS Retrospective cohort study using data from a Medicare Advantage (MA) plan. Patients with ≥1 claim for COPD at baseline, ≥65 years, continuous 24-months enrollment and without any cancer/end stage renal disease diagnosis were eligible. Patients not reaching the coverage gap (no coverage gap) were matched and compared to those reaching the coverage gap and those reaching catastrophic coverage in separate analyses. Chi-square tests and Cox proportional hazards model were used to compare outcomes across matched cohorts. RESULTS In total, 3142 COPD patients were identified (79% no coverage gap, 10% coverage gap, and 11% catastrophic coverage). Compared to the no coverage gap group, a larger number of beneficiaries in the coverage gap group had ≥1 hospitalization (26% vs 32%, p < .05), ≥ 1 ER visits (43% vs 49%, p < .05), and ≥1 hospitalization/ER (total visit) (47% vs 54%, p < .05), respectively. Compared to the no coverage gap group, a greater number of beneficiaries in catastrophic coverage had ≥1 ER visit (45% vs 53%, p < .05) or ≥1 total visits (48% vs 56%, p < .05), respectively. Time to hospitalization was shorter among those entering the coverage gap as compared to the no coverage gap [Hazards Ratio (HR) = 1.5; p = .040]. CONCLUSIONS COPD patients entering the coverage gap and catastrophic coverage were associated with increased utilization of healthcare services. Entering the coverage gap was also associated with shorter time to hospitalization as compared to the no coverage gap.
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Affiliation(s)
- Sujit S Sansgiry
- a University of Houston College of Pharmacy , Houston , TX , USA
| | - Archita Bhansali
- a University of Houston College of Pharmacy , Houston , TX , USA
| | - Omar Serna
- b Cigna-HealthSpring , Houston , TX , USA
| | | | - Marc Fleming
- a University of Houston College of Pharmacy , Houston , TX , USA
| | - Susan Abughosh
- a University of Houston College of Pharmacy , Houston , TX , USA
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28
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Rai KK, Adab P, Ayres JG, Jordan RE. Systematic review: chronic obstructive pulmonary disease and work-related outcomes. Occup Med (Lond) 2019. [PMID: 29528460 DOI: 10.1093/occmed/kqy012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Several studies have assessed the impact of chronic obstructive pulmonary disease (COPD) on work ability and work productivity; however, this relationship is poorly understood. Aims To undertake a systematic review to assess the effects of COPD on employment, absenteeism and presenteeism. Methods A comprehensive search using CINAHL, Embase, MEDLINE and the Cochrane Library was conducted to include epidemiological studies from 1937 to August 2017. One reviewer screened all citations. Shortlisted full-text articles were independently assessed by a second reviewer. Data were extracted by one reviewer with a random sample of papers (45%) checked by a second reviewer. Results Forty-four studies were included; the majority of evidence was from cross-sectional studies, and some cohort studies. COPD patients had lower employment rates than those without COPD. Among those in work, most studies showed patients with COPD took more time off work than those without and reported poorer work performance (presenteeism), although evidence for this association was weaker. The influence of disease severity on these outcomes was unclear; however, it appeared that increasing severity of airflow obstruction was associated with reduced likelihood of being employed. A number of methodological limitations were found among the evidence, including the lack of adjustment for important confounders. Conclusions Future studies are required which assess the impact of COPD on presenteeism using validated presenteeism instruments and consistent reporting methods. Robust studies are now needed to identify modifiable factors associated with these poorer working outcomes to inform future interventions aimed at improving work productivity among those with COPD.
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Affiliation(s)
- K K Rai
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - J G Ayres
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Lakiang T, Nair NS, Ramaswamy A, Singhal U. Economic impact of chronic obstructive pulmonary disease: A cross-sectional study at teaching hospital in South India. J Family Med Prim Care 2019; 7:1002-1006. [PMID: 30598947 PMCID: PMC6259545 DOI: 10.4103/jfmpc.jfmpc_75_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Chronic obstructive pulmonary disease continues to be the important contribution toward disability, death, and burden in the costs of health care globally. Economic impact of COPD is attributed with substantial direct and indirect costs. COPD affects the productivity of work that poses a burden on the employers and also on individuals in terms of loss of pay, limitation of activities, and related disability. Materials and Methods Hospital-based cross-sectional study among 24 respondents in selected hospital in Udupi Taluk. Respondents were identified by purposive sampling technique and data were collected in respondent's mother tongue. An interviewer administered questionnaire was used to collect data related to patient's demographic status, disease history, and direct and indirect costs of COPD. Data were analyzed using SPSS software version 15. Results The mean total direct medical cost that was observed among 24 respondents was Rs. 29,885 ± 11,995.33 and the mean total direct nonmedical cost was Rs. 7,441.25 ± 2,228.90. The mean total direct medical costs of COPD patients with comorbidity were Rs. 28,148.2353 ± 2,578.01580 and for those without comorbid illness was Rs. 13,460.0000 ± 1,255.33528. The observed mean absenteeism in the past 28 days was 193.50 ± 33.62 h. The mean absolute presenteeism of respondents is 72.05 ± 7.55. Conclusions The major drivers of the total cost were cost of hospitalizations and medication costs. Acknowledging the costs and economic impact of COPD is therefore extremely important in the management of COPD and in reducing the mortality and morbidity related to COPD and in improving adherence to treatment.
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Affiliation(s)
- Theophilus Lakiang
- Department of Public Health, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
| | - N Sreekumaran Nair
- Department of Public Health, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
| | - Aarthy Ramaswamy
- Department of Public Health, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
| | - Umang Singhal
- Department of Public Health, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
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30
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Oba Y, Keeney E, Ghatehorde N, Dias S. Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis. Cochrane Database Syst Rev 2018; 12:CD012620. [PMID: 30521694 PMCID: PMC6517098 DOI: 10.1002/14651858.cd012620.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Long-acting bronchodilators such as long-acting β-agonist (LABA), long-acting muscarinic antagonist (LAMA), and LABA/inhaled corticosteroid (ICS) combinations have been used in people with moderate to severe chronic obstructive pulmonary disease (COPD) to control symptoms such as dyspnoea and cough, and prevent exacerbations. A number of LABA/LAMA combinations are now available for clinical use in COPD. However, it is not clear which group of above mentioned inhalers is most effective or if any specific formulation works better than the others within the same group or class. OBJECTIVES To compare the efficacy and safety of available formulations from four different groups of inhalers (i.e. LABA/LAMA combination, LABA/ICS combination, LAMA and LABA) in people with moderate to severe COPD. The review will update previous systematic reviews on dual combination inhalers and long-acting bronchodilators to answer the questions described above using the strength of a network meta-analysis (NMA). SEARCH METHODS We identified studies from the Cochrane Airways Specialised Register, which contains several databases. We also conducted a search of ClinicalTrials.gov and manufacturers' websites. The most recent searches were conducted on 6 April 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) that recruited people aged 35 years or older with a diagnosis of COPD and a baseline forced expiratory volume in one second (FEV1) of less than 80% of predicted. We included studies of at least 12 weeks' duration including at least two active comparators from one of the four inhaler groups. DATA COLLECTION AND ANALYSIS We conducted NMAs using a Bayesian Markov chain Monte Carlo method. We considered a study as high risk if recruited participants had at least one COPD exacerbation within the 12 months before study entry and as low risk otherwise. Primary outcomes were COPD exacerbations (moderate to severe and severe), and secondary outcomes included symptom and quality-of-life scores, safety outcomes, and lung function. We collected data only for active comparators and did not consider placebo was not considered. We assumed a class/group effect when a fixed-class model fitted well. Otherwise we used a random-class model to assess intraclass/group differences. We supplemented the NMAs with pairwise meta-analyses. MAIN RESULTS We included a total of 101,311 participants from 99 studies (26 studies with 32,265 participants in the high-risk population and 73 studies with 69,046 participants in the low-risk population) in our systematic review. The median duration of studies was 52 weeks in the high-risk population and 26 weeks in the low-risk population (range 12 to 156 for both populations). We considered the quality of included studies generally to be good.The NMAs suggested that the LABA/LAMA combination was the highest ranked treatment group to reduce COPD exacerbations followed by LAMA in the both populations.There is evidence that the LABA/LAMA combination decreases moderate to severe exacerbations compared to LABA/ICS combination, LAMA, and LABA in the high-risk population (network hazard ratios (HRs) 0.86 (95% credible interval (CrI) 0.76 to 0.99), 0.87 (95% CrI 0.78 to 0.99), and 0.70 (95% CrI 0.61 to 0.8) respectively), and that LAMA decreases moderate to severe exacerbations compared to LABA in the high- and low-risk populations (network HR 0.80 (95% CrI 0.71 to 0.88) and 0.87 (95% CrI 0.78 to 0.97), respectively). There is evidence that the LABA/LAMA combination reduces severe exacerbations compared to LABA/ICS combination and LABA in the high-risk population (network HR 0.78 (95% CrI 0.64 to 0.93) and 0.64 (95% CrI 0.51 to 0.81), respectively).There was a general trend towards a greater improvement in symptom and quality-of-life scores with the combination therapies compared to monotherapies, and the combination therapies were generally ranked higher than monotherapies.The LABA/ICS combination was the lowest ranked in pneumonia serious adverse events (SAEs) in both populations. There is evidence that the LABA/ICS combination increases the odds of pneumonia compared to LAMA/LABA combination, LAMA and LABA (network ORs: 1.69 (95% CrI 1.20 to 2.44), 1.78 (95% CrI 1.33 to 2.39), and 1.50 (95% CrI 1.17 to 1.92) in the high-risk population and network or pairwise OR: 2.33 (95% CI 1.03 to 5.26), 2.02 (95% CrI 1.16 to 3.72), and 1.93 (95% CrI 1.29 to 3.22) in the low-risk population respectively). There were significant overlaps in the rank statistics in the other safety outcomes including mortality, total, COPD, and cardiac SAEs, and dropouts due to adverse events.None of the differences in lung function met a minimal clinically important difference criterion except for LABA/LAMA combination versus LABA in the high-risk population (network mean difference 0.13 L (95% CrI 0.10 to 0.15). The results of pairwise meta-analyses generally agreed with those of the NMAs. There is no evidence to suggest intraclass/group differences except for lung function at 12 months in the high-risk population. AUTHORS' CONCLUSIONS The LABA/LAMA combination was the highest ranked treatment group to reduce COPD exacerbations although there was some uncertainty in the results. LAMA containing inhalers may have an advantage over those without a LAMA for preventing COPD exacerbations based on the rank statistics. Combination therapies appear more effective than monotherapies for improving symptom and quality-of-life scores. ICS-containing inhalers are associated with an increased risk of pneumonia.Our most comprehensive review including intraclass/group comparisons, free combination therapies, 99 studies, and 20 outcomes for each high- and low-risk population summarises the current literature and could help with updating existing COPD guidelines.
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Affiliation(s)
- Yuji Oba
- University of MissouriDivision of Pulmonary and Critical Care MedicineColumbiaMOUSA
| | - Edna Keeney
- University of BristolPopulation Health Sciences, Bristol Medical SchoolBristolUK
| | - Namratta Ghatehorde
- University of MissouriDivision of Pulmonary and Critical Care MedicineColumbiaMOUSA
| | - Sofia Dias
- University of YorkCentre for Reviews and DisseminationHeslingtonYorkUKYO10 5DD
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Everhov ÅH, Khalili H, Askling J, Myrelid P, Ludvigsson JF, Halfvarson J, Nordenvall C, Söderling J, Olén O, Neovius M. Sick Leave and Disability Pension in Prevalent Patients With Crohn's Disease. J Crohns Colitis 2018; 12:1418-1428. [PMID: 30165593 DOI: 10.1093/ecco-jcc/jjy123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease may affect the ability to work and lead to permanent disability. We aimed to investigate work loss in prevalent patients. METHODS We identified patients with Crohn's disease and general population comparators matched by sex, birth year, healthcare region and education. We assessed days of sick leave and disability pension retrieved from the Swedish Social Insurance Agency and estimated the absolute and relative risk of receiving disability pension [minimum 25% work impairment]. RESULTS In 2014, the 20638 Crohn's disease patients [median age 44 years] had more than twice as many mean lost workdays [disability pension: 44; sick leave: 19] as the 102038 comparators [disability pension: 20; sick leave: 8], mean difference 35 days [95% confidence interval 33-37]. However, the majority had no lost workdays [68% of patients and 85% of comparators]. The proportion of patients receiving disability pension was 15% (6.5% in the comparators, risk ratio 2.34 [2.25-2.43]) and was higher in all subgroups, especially in female patients [28% vs 13% in the comparators], in those with ≤9 years of education [41% vs 23%] and in ages 60-64 years [46% vs 25%]. The relative risk of disability pension within the patient cohort [adjusted for age, sex, region and education] was higher in patients with complicated disease behaviour, extraintestinal manifestations, need of surgery or treatment with biologics. The differences between patients and comparators remained when comparing other calendar years [2006-2013]. CONCLUSION Work loss was found in approximately one-third of patients. The mean number of lost workdays was twice as high as in the comparators.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pär Myrelid
- Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Kim C, Kim Y, Yang DW, Rhee CK, Kim SK, Hwang YI, Park YB, Lee YM, Jin S, Park J, Hahm CR, Park CH, Park SY, Jung CK, Kim YI, Lee SH, Yoon HK, Lee JH, Lim SY, Yoo KH. Direct and Indirect Costs of Chronic Obstructive Pulmonary Disease in Korea. Tuberc Respir Dis (Seoul) 2018; 82:27-34. [PMID: 30302958 PMCID: PMC6304326 DOI: 10.4046/trd.2018.0035] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. Methods This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. Results The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. Conclusion This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.
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Affiliation(s)
- Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Younhee Kim
- Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea
| | - Dong Wook Yang
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Kyoung Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yong Il Hwang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Bum Park
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | | | | | - Jinkyeong Park
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cho Rom Hahm
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Seoul, Korea
| | - Chang Han Park
- Department of Internal Medicine, Sungae Hospital, Seoul, Korea
| | | | | | - Yu Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Haak Lee
- Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung Kyu Yoon
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hwa Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seong Yong Lim
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
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Anzueto A, Miravitlles M. Chronic Obstructive Pulmonary Disease Exacerbations: A Need for Action. Am J Med 2018; 131:15-22. [PMID: 29777660 DOI: 10.1016/j.amjmed.2018.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with exacerbations contributing strongly to the overall severity and burden of disease at the individual level. Many patients with COPD are managed predominantly in the primary care setting; therefore, primary care physicians (PCPs) must be aware of and understand the causes, effects, and management of COPD exacerbations. This review offers practical information about how exacerbations are defined in the treatment setting, pathogenic and environmental causes, options for exacerbation treatment and prevention, and suggestions for improving care in the clinic. Exacerbations have a strong negative effect on patients and are associated with an increased risk of further exacerbations and decreases in lung function. Thus, it is important that exacerbations not requiring hospitalization be identified and confidently managed in the clinical setting. Understanding treatment options for acute exacerbations and maintenance treatment to prevent future exacerbations may help PCPs better understand what they can do to support their patients. This review aims to provide useful guidance for PCPs to identify exacerbations and adjust their practice for optimal management of exacerbations in patients with COPD. It also aims to encourage PCPs that they have an important task in integrating effective COPD management into the primary care setting.
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Affiliation(s)
- Antonio Anzueto
- University of Texas Health Science Center at San Antonio, Department of Medicine, Pulmonary/Critical Care, South Texas Veterans Health Care System, San Antonio, Texas, USA.
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Igarashi A, Fukuchi Y, Hirata K, Ichinose M, Nagai A, Nishimura M, Yoshisue H, Ohara K, Gruenberger JB. COPD uncovered: a cross-sectional study to assess the socioeconomic burden of COPD in Japan. Int J Chron Obstruct Pulmon Dis 2018; 13:2629-2641. [PMID: 30214181 PMCID: PMC6118262 DOI: 10.2147/copd.s167476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background COPD remains a major health problem in Japan. Patients with COPD experience a reduced quality of life (QoL) and have a higher chance of work impairment and productivity loss. However, there is a lack of data on the impact of COPD in terms of QoL and work activity impairment in Japan. This study assessed the socioeconomic burden of COPD in Japan and the impact it may have on the working age population. Patients and methods This was a 2-year retrospective chart review in COPD patients aged ≥40 years, with at least one health care visit to clinic or hospital in the previous 12 months. Patients were required to have available medical charts for at least the previous 24 months. Symptoms were assessed using COPD assessment test score; EuroQoL Group 5 Dimension (EQ-5D-5L) and work productivity and activity impairment general health questionnaires were used to evaluate health-related QoL and work productivity, and health care resource utilization data were obtained from clinical charts. Results In total, 71 patients aged <65 years, and 151 patients aged ≥65 years were included; the majority of patients had moderate or severe airflow limitation. Exacerbations (moderate or severe) were reported by ~35% of patients in both age groups; 52.1% and 62.9% of patients in the <65-year and ≥65-year age groups had COPD assessment test scores ≥10. EQ-5D-5L index scores in the <65-year and ≥65-year age groups were 0.79 and 0.77, respectively. Work productivity and activity impairment scores were higher in <65-year age group. Annual costs of health care resource use per patient in the <65-year and ≥65-year age groups were ¥438,975 (US$4,389) and ¥467,871 (US$4,678), respectively. Costs due to productivity loss were estimated to be ¥5,287,024 (US$52,870) in the <65-year age group and ¥3,018,974 (US$30,187) in the ≥65-year age group. Conclusion COPD represents a significant socioeconomic burden in Japan. Patients with COPD report significant use of health care resources. Higher impact on work impairment and productivity loss was observed frequently in the working age population.
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Affiliation(s)
- Ataru Igarashi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan,
| | - Yoshinosuke Fukuchi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Nagai
- Research Institute for Respiratory Diseases, Shin-Yurigaoka General Hospital, Kawasaki City, Japan
| | - Masaharu Nishimura
- Department of Pulmonary Medicine, Faculty School of Medicine, Hokkaido University, Hokkaido, Japan
| | | | - Kenichi Ohara
- Market Access Division, Novartis Pharma K.K., Tokyo, Japan
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Patel JG, Coutinho AD, Lunacsek OE, Dalal AA. COPD affects worker productivity and health care costs. Int J Chron Obstruct Pulmon Dis 2018; 13:2301-2311. [PMID: 30104870 PMCID: PMC6072680 DOI: 10.2147/copd.s163795] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose This study aimed to measure the true burden of COPD by calculating incremental direct and indirect costs. Direct medical resource use, productivity metrics, and COPD-specific resource use and costs were also evaluated. Patients and methods This was a retrospective, observational, matched cohort study using administrative claims data from the Truven Health MarketScan® Commercial Claims and Encounters and the Health and Productivity Management databases (2007-2010). Working-age (18-65 years) patients with COPD were identified as having at least one hospitalization or one emergency department visit or two outpatient visits. Patients in the non-COPD cohort did not have a diagnosis of COPD during the study period. Outcomes were evaluated in the first full calendar year after the year of identification (index). Results Of the 5,701 patients with COPD identified, 3.6% patients were frequent exacerbators (≥2), 10.4% patients were infrequent exacerbators (1), and 86% patients were non-exacerbators (0). When compared with the 17,103 patients without COPD, the incremental direct cost of COPD was estimated at $6,246/patient/year (95% confidence interval: $4,620, $8,623; P<0.001). Loss in productivity was significantly greater in patients with COPD, with an average of 5 more days/year of absence from work and incremental indirect costs from short-term disability of $641 (P<0.001). Direct costs for frequent exacerbators ($17,651/year) and infrequent exacerbators ($14,501/year) were significantly higher than those for non-exacerbators ($11,395, P<0.001). Conclusion Working-age patients with COPD incur statistically significantly higher direct and indirect costs and use more resources compared with those who do not have COPD.
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Affiliation(s)
| | | | | | - Anand A Dalal
- US Health Economics and Outcomes Research, Novartis Pharmaceuticals, East Hanover, NJ, USA
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Associations Between COPD Severity and Work Productivity, Health-Related Quality of Life, and Health Care Resource Use: A Cross-Sectional Analysis of National Survey Data. J Occup Environ Med 2018; 58:e191-7. [PMID: 27206123 DOI: 10.1097/jom.0000000000000735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the associations between presence of chronic obstructive pulmonary disease (COPD) and increasing COPD severity with work productivity and activity impairment (WPAI), health-related quality of life (HRQoL), and health care resource use (HCRU) in employed adults. METHODS Employed adults aged at least 40 years from the 2010 to 2012 US National Health and Wellness Survey were selected for this study. Associations of interest were assessed using multivariate regression models. RESULTS The study sample consisted of 60,389 respondents with 4.1% reporting a physician diagnosis of COPD. Of these, 55.4%, 37.6%, and 7.0% reported their COPD severity was mild, moderate, and severe, respectively. The presence of COPD and increasing COPD severity was associated with higher WPAI, lower HRQoL, and higher HCRU (all P < 0.001). CONCLUSION In an employed population, presence of COPD and increasing COPD severity negatively impacts health outcomes, particularly work productivity.
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Fernandes JR, Marques da Silva CCB, da Silva AG, de Carvalho Pinto RM, da Silva Duarte AJ, Carvalho CR, Benard G. Effect of an Exercise Program on Lymphocyte Proliferative Responses of COPD Patients. Lung 2018. [PMID: 29525851 DOI: 10.1007/s00408-018-0107-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Exercise training has been shown to reduce symptoms and exacerbations in COPD patients; however, the exercise effect on patients' immune response is poorly known. We thus verified if an exercise program (EP) impacted on proliferative T cell response of COPD patients. Fourteen non-O2 dependent COPD patients on standard treatment were studied. EP consisted in 24 sessions of aerobic and muscular training. Peripheral blood mononuclear cells were stimulated with the mitogen phytohemagglutinin and antigens from Haemophilus influenzae and cytomegalovirus, and the lymphocyte proliferative response (LPR) was assessed through the expression of Ki67 before and after the EP. The Quality of life [COPD assessment test (CAT)], dyspnea [(modified Medical Research Council scale (mMRC)], and 6-min walk distance were also assessed. The EP program increased significantly the LPR of TCD4+ lymphocytes to phytohemagglutinin and cytomegalovirus and H. influenzae antigens, but with TCD8+ lymphocytes the increase was less marked. Consistent with this, a higher proportion of TCD8+ than TCD4+ cells did not express the costimulatory molecule CD28. The EP also resulted in improvement of the quality of life, dyspnea, and physical capacity. The improvement in TCD4+ cell function may represent an additional mechanism through which the EP results in less exacerbations and hospitalizations.
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Affiliation(s)
- Juliana Ruiz Fernandes
- Laboratory of Dermatology and Immunodeficiencies (LIM56), School of Medicine, São Paulo University, Av. Dr. Arnaldo, 455, São Paulo, Brazil
| | | | - Aline Grandi da Silva
- Department of Physical Therapy, School of Medicine, São Paulo University, R. Dr. Ovídio Pires de Campos, 255, São Paulo, Brazil
| | - Regina Maria de Carvalho Pinto
- Pulmonary Department, Heart Institute (InCor), School of Medicine, São Paulo University, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Laboratory of Dermatology and Immunodeficiencies (LIM56), School of Medicine, São Paulo University, Av. Dr. Arnaldo, 455, São Paulo, Brazil
| | - Celso Ricardo Carvalho
- Department of Physical Therapy, School of Medicine, São Paulo University, R. Dr. Ovídio Pires de Campos, 255, São Paulo, Brazil
| | - Gil Benard
- Laboratory of Dermatology and Immunodeficiencies (LIM56), School of Medicine, São Paulo University, Av. Dr. Arnaldo, 455, São Paulo, Brazil.
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Donohue JF, Bollu VK, Stull DE, Nelson LM, Williams VSL, Stensland MD, Hanania NA. Long-term health-related quality-of-life and symptom response profiles with arformoterol in COPD: results from a 52-week trial. Int J Chron Obstruct Pulmon Dis 2018; 13:499-508. [PMID: 29440887 PMCID: PMC5804733 DOI: 10.2147/copd.s141729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Symptom severity is the largest factor in determining subjective health in COPD. Symptoms (eg, chronic cough, dyspnea) are associated with decreased health-related quality of life (HRQoL). We evaluated the impact of arformoterol on HRQoL in COPD patients, measured by St George's Respiratory Questionnaire (SGRQ). Post hoc growth mixture model (GMM) analysis examined symptom response profiles. Methods We examined data from a randomized, double-blind, parallel-group, 12-month safety trial of twice-daily nebulized arformoterol 15 µg (n=420) versus placebo (n=421). COPD severity was assessed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) status. GMM analysis identified previously unknown patient subgroups and examined the heterogeneity in response to SGRQ Symptoms scores. Results SGRQ Total score improved by 4.24 points with arformoterol and 2.02 points with placebo (P=0.006). Significantly greater improvements occurred for arformoterol versus placebo in SGRQ Symptoms (6.34 vs 4.25, P=0.031) and Impacts (3.91 vs 0.97, P=0.001) scores, but not in Activity score (3.57 vs 1.75, P=0.057). GMM identified responders and nonresponders based on the SGRQ Symptoms score. End-of-study mean difference in SGRQ Symptoms scores between these latent classes was 20.7 points (P<0.001; 95% confidence interval: 17.6-23.9). Compared with nonresponders, responders were more likely current smokers (55.52% vs 44.02%, P=0.0021) and had more severe COPD (forced expiratory volume in 1 second [FEV1]: 1.16 vs 1.23 L, P=0.0419), more exacerbations (0.96 vs 0.69, P=0.0018), and worse mean SGRQ Total (59.81 vs 40.57, P<0.0001), Clinical COPD Questionnaire (3.29 vs 2.05, P<0.0001), and Modified Medical Research Council Dyspnea Scale (3.13 vs 2.75, P<0.0001) scores. Arformoterol-receiving responders exhibited significantly greater improvements in FEV1 (0.09 vs 0.008, P=0.03) and fewer hospitalizations (0.13 vs 0.24, P=0.02) than those receiving placebo. Conclusion In this study, arformoterol treatment significantly improved HRQoL reflected by SGRQ. For the analysis performed on these data, arformoterol may be particularly effective in improving lung function and reducing hospitalizations among patients who are unable to quit smoking or present with more severe symptoms.
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Affiliation(s)
- James F Donohue
- Department of Pulmonary Diseases and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vamsi K Bollu
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ
| | | | - Lauren M Nelson
- Psychometrics, RTI Health Solutions, Research Triangle Park, NC
| | | | | | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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Lisspers K, Larsson K, Johansson G, Janson C, Costa-Scharplatz M, Gruenberger JB, Uhde M, Jorgensen L, Gutzwiller FS, Ställberg B. Economic burden of COPD in a Swedish cohort: the ARCTIC study. Int J Chron Obstruct Pulmon Dis 2018; 13:275-285. [PMID: 29391785 PMCID: PMC5769573 DOI: 10.2147/copd.s149633] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting. Patients and methods Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed. Results A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013. Conclusion As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.
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Affiliation(s)
- Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
| | - Kjell Larsson
- Department of Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Solna
| | - Gunnar Johansson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala
| | | | | | | | | | | | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
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Pulmonary Rehabilitation Improves Outcomes in Chronic Obstructive Pulmonary Disease Independent of Disease Burden. Ann Am Thorac Soc 2017; 14:26-32. [PMID: 27739881 DOI: 10.1513/annalsats.201607-551oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Current practice guidelines recommend pulmonary rehabilitation as an adjunct to standard pharmacologic therapy for individuals with moderate to severe chronic obstructive pulmonary disease (COPD). Whether pulmonary rehabilitation benefits all subjects with COPD independent of baseline disease burden is not known. OBJECTIVES To test whether pulmonary rehabilitation benefits patients with COPD independent of baseline exercise capacity, dyspnea, and lung function. METHODS Data from a prospectively maintained database of participants with COPD enrolled in pulmonary rehabilitation at the University of Alabama at Birmingham from 1996 to 2013 were retrospectively analyzed. Subjects were divided into four quartiles based on their baseline level of dyspnea as assessed by the San Diego Shortness of Breath Questionnaire at the initial visit. Similar quartiles were assessed for FEV1 percent predicted as well as the 6-minute-walk distance (6MWD). The primary outcome was the change in quality of life as measured by the 36-item Short Form Health Survey (SF-36). Secondary outcomes were change in dyspnea, 6MWD, and depression scores assessed using the Beck Depression Inventory-II. Differences between baseline and final scores were compared using paired t tests and across quartiles using analysis of variance. MEASUREMENTS AND MAIN RESULTS A total of 229 subjects were included. Their mean age was 66.5 (SD, 9) years. Ninety-one (40%) were female, and 42 (18%) were African American. The mean FEV1 percent predicted was 46.3% (20.0%). On completion of pulmonary rehabilitation, clinically significant improvements were seen in most components of SF-36: physical function, 11.5 (95% confidence interval [CI], 7.4-15.5; P < 0.001); health perception, 2.1 (95% CI, -0.7 to 4.8; P = 0.12); physical role, 16.7 (95% CI, 10.3-23.1; P < 0.001); emotional role, 14.7 (95% CI, 7.1-22.3; P < 0.001); social function, 16.4 (95% CI, 11.3-21.5; P < 0.001); mental health, 5.4 (95% CI, 2.6-8.3; P < 0.001); pain, 5 (95% CI, 1-9.1; P = 0.02); vitality, 12.4 (95% CI, 8.8-16.1; P < 0.001); and depression, 0.01 (95% CI, -0.11 to 0.07; P = 0.54). There was no difference in improvement in SF-36 across quartiles of San Diego Shortness of Breath Questionnaire, 6MWD, and FEV1 percent predicted. CONCLUSIONS Pulmonary rehabilitation results in significant improvement in quality of life, dyspnea, and functional capacity independent of baseline disease burden.
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A Comparative Life Cycle Assessment between a Metered Dose Inhaler and Electric Nebulizer. SUSTAINABILITY 2017. [DOI: 10.3390/su9101725] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mantoani LC, Dell'Era S, MacNee W, Rabinovich RA. Physical activity in patients with COPD: the impact of comorbidities. Expert Rev Respir Med 2017; 11:685-698. [PMID: 28699821 DOI: 10.1080/17476348.2017.1354699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD) and it plays an important role on physical activity (PA) in this population. Since low PA levels have been described as a key factor to predict morbi-mortality in COPD, it seems crucial to review the current literature available on this topic. Areas covered: This review covers the most common comorbidities found in COPD, their prevalence and prognostic implications. We explore the differences in PA between COPD patients with and without comorbidities, as well as the impact of the number or type of comorbidities on activity levels of this population. The effect of different comorbidities on activities of daily living in patients with COPD is also reviewed. Finally, we discuss options for the treatment of inactivity in COPD patients considering their comorbidities and limitations. Expert commentary: Comorbidities are highly prevalent in patients with COPD and further deteriorate PA levels in this population. Despite the wide range of interventions available in COPD, the evidence in the field seems to point at PA coaching with feedback on individual goals and longer lasting PR programmes with more than 12 weeks of duration when attempting to raise the activity levels of this population.
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Affiliation(s)
- Leandro Cruz Mantoani
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
| | - Silvina Dell'Era
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK.,b Sección de Rehabilitación y Cuidados Respiratorios, Servicio de Kinesiología, Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - William MacNee
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
| | - Roberto A Rabinovich
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
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Shakshuki A, Agu RU. Improving the Efficiency of Respiratory Drug Delivery: A Review of Current Treatment Trends and Future Strategies for Asthma and Chronic Obstructive Pulmonary Disease. Pulm Ther 2017; 3:267-281. [PMID: 32026344 PMCID: PMC6964260 DOI: 10.1007/s41030-017-0046-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 12/23/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous airway diseases associated with significant morbidity and mortality. Pharmacological treatment is delivered primarily through the inhalation route using various devices. Optimal disease control is highly dependent upon patient adherence. Both patients with asthma and COPD are prone to exacerbations leading to hospitalization, which can significantly impact quality of life. Poor adherence is a complex and multifactorial problem that does not have one simple solution. However, it is the biggest risk factor for exacerbations and consequently high healthcare utilization. This review discusses the complex and multifactorial obstacles that impact patient adherence as well as the effect on overall treatment outcomes and healthcare utilization. We also critically examined and compared relatively recent improvements in breath-activated pressurized metered dose inhalers, dry powder inhalers, and e-technology in asthma and COPD. Finally, future treatment strategies for better patient compliance such as personalized medicine and the importance of decision-making between patients and physicians were highlighted.
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Affiliation(s)
- Ayah Shakshuki
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, Halifax, Canada
| | - Remigius U Agu
- Biopharmaceutics and Drug Delivery Lab, College of Pharmacy, Halifax, Canada.
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Tachkov K, Kamusheva M, Pencheva V, Mitov K. Evaluation of the economic and social burden of chronic obstructive pulmonary disease (COPD). BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1335616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Konstantin Tachkov
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Ventsislava Pencheva
- Department of Propaedeutic of Internal Diseases, UMHAT ‘Alexandrovska’, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Mitov
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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Bourdin A, Molinari N. [What are the socio-economic consequences of acute COPD exacerbations?]. Rev Mal Respir 2017; 34:338-342. [PMID: 28476415 DOI: 10.1016/j.rmr.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Bourdin
- Inserm U1046, département de pneumologie et addictologie, CHU de Montpellier, 34070 Montpellier, France
| | - N Molinari
- Inserm U1046, département de pneumologie et addictologie, CHU de Montpellier, 34070 Montpellier, France.
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Kamusheva M, Dimitrova M, van Boven JFM, Postma MJ, van der Molen T, Kocks JWH, Mitov K, Doneva M, Petrova D, Georgiev O, Petkova V, Petrova G. Clinical characteristics, treatment patterns, and socio-economic burden of COPD in Bulgaria. J Med Econ 2017; 20:503-509. [PMID: 28058859 DOI: 10.1080/13696998.2017.1279620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case. METHODS A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed. RESULTS A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times. CONCLUSIONS Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.
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Affiliation(s)
- Maria Kamusheva
- a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria
| | - Maria Dimitrova
- a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria
| | - Job F M van Boven
- b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
- c Unit of Pharmacotherapy , Epidemiology and - Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Maarten J Postma
- c Unit of Pharmacotherapy , Epidemiology and - Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
- d Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen , Groningen , The Netherlands
- e Department of Epidemiology , University Medical Center Groningen (UMCG), University of Groningen , Groningen , The Netherlands
| | - Thys van der Molen
- b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Janwillem W H Kocks
- b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
- f Department of General Practice , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Konstantin Mitov
- a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria
| | - Miglena Doneva
- a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria
| | - Daniela Petrova
- g Department of Propaedeutic of Internal Diseases , UMHAT 'Alexandrovska', Medical University , Sofia , Bulgaria
| | - Ognyan Georgiev
- g Department of Propaedeutic of Internal Diseases , UMHAT 'Alexandrovska', Medical University , Sofia , Bulgaria
| | - Valentina Petkova
- a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria
| | - Guenka Petrova
- a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria
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Adrish M, Nannaka VB, Cano EJ, Bajantri B, Diaz-Fuentes G. Significance of NT-pro-BNP in acute exacerbation of COPD patients without underlying left ventricular dysfunction. Int J Chron Obstruct Pulmon Dis 2017; 12:1183-1189. [PMID: 28458528 PMCID: PMC5402900 DOI: 10.2147/copd.s134953] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND B-type natriuretic peptide (BNP) and the N-terminal fragment of pro-BNP (NT-pro-BNP) are established biomarkers of heart failure. Increased levels of natriuretic peptide (NP) have been associated with poor outcomes in acute exacerbation of COPD (AECOPD); however, most studies did not address the conditions that can also increase NT-pro-BNP levels. We aimed to determine if NT-pro-BNP levels correlate with outcomes of AECOPD in patients without heart failure and other conditions that can affect NT-pro-BNP levels. METHODS We conducted a retrospective study in patients hospitalized for AECOPD with available NT-pro-BNP levels and normal left ventricular ejection fraction. We compared patients with normal and elevated NT-pro-BNP levels and analyzed the clinical and outcome data. RESULTS A total of 167 of 1,420 (11.7%) patients met the study criteria. A total of 77% of male patients and 53% of female patients had elevated NT-pro-BNP levels (P=0.0031). NT-pro-BNP levels were not associated with COPD severity and comorbid illnesses. Log-transformed NT-pro-BNP levels were positively associated with echocardiographically estimated right ventricular systolic pressure (r=0.3658; 95% confidence interval [CI]: 0.2060-0.5067; P<0.0001). Patients with elevated NT-pro-BNP levels were more likely to require intensive care (63% vs 43%; P=0.0207) and had a longer hospital length of stay (P=0.0052). There were no differences in the need for noninvasive positive pressure ventilation (P=0.1245) or mechanical ventilation (P=0.9824) or in regard to in-hospital mortality (P=0.5273). CONCLUSION Patients with AECOPD and elevated NT-pro-BNP levels had increased hospital length of stay and need for intensive care. Based on our study, serum NT-pro-BNP levels cannot be used as a biomarker for increased mortality or requirement for invasive or noninvasive ventilation in this group of patients.
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Affiliation(s)
- Muhammad Adrish
- Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai
| | - Varalaxmi Bhavani Nannaka
- Department of Critical Care Medicine, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine
| | - Edison J Cano
- Department of Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Bharat Bajantri
- Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai
| | - Gilda Diaz-Fuentes
- Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai
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Oba Y, Fadila M, Keeney E, Dias S. Fixed-dose combination inhalers compared to long-acting bronchodilators for COPD: a network meta-analysis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Yuji Oba
- University of Missouri; School of Medicine; Columbia MO USA
| | - Mario Fadila
- University of Missouri; School of Medicine; Columbia MO USA
| | - Edna Keeney
- University of Bristol; School of Social and Community Medicine; Bristol UK
| | - Sofia Dias
- University of Bristol; School of Social and Community Medicine; Bristol UK
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Rai KK, Jordan RE, Siebert WS, Sadhra SS, Fitzmaurice DA, Sitch AJ, Ayres JG, Adab P. Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:233-242. [PMID: 28138233 PMCID: PMC5238806 DOI: 10.2147/copd.s119467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. METHODS Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. RESULTS In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. CONCLUSION This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.
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Affiliation(s)
| | | | | | - Steven S Sadhra
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | - Jon G Ayres
- Institute of Applied Health Research
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Montes de Oca M, Aguirre C, Lopez Varela MV, Laucho-Contreras ME, Casas A, Surmont F. Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study. Int J Chron Obstruct Pulmon Dis 2016; 11:3059-3067. [PMID: 27994446 PMCID: PMC5153276 DOI: 10.2147/copd.s120776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. Objectives To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. Conclusion COPD, asthma, and asthma–COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.
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Affiliation(s)
- Maria Montes de Oca
- Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | | | | | - Maria E Laucho-Contreras
- Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Filip Surmont
- Medical Affairs, AstraZeneca Latin America, Coral Gables, FL, USA
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